James Holland, a medical oncologist and one of the fathers of modern chemotherapy aptly says that there is one experience that is common to every type of cancer, and that is worry. Worry is a natural part of our contemporary human condition. After finding out one has cancer, that skill has license to over-work. There are many venues for worry: that we won't survive the treatment or that we will be in pain, disfigured, disabled or dependent on our health care delivery system and caregivers. Most of all, often in private and late at night when the noise of the day has subsided, the worry turns to thinking about premature death or suffering. These thoughts are often a rite of passage, whether shared with our families and friends or in silence. It is very hard not to worry. Yet, some erroneous conventional wisdom wrongly suggests that worry brings cancer on or renders treatment unsuccessful, so it is important to think good thoughts. A noble attempt at cheerleading, perhaps, but awfully impossible.

Worry itself is very different from anxiety, though we often mistakenly use those words interchangeably. Anxiety is a foreboding for the future for things are not likely to happen. There is generally a biologic predisposition as well as many environmental factors that sustain and reinforce anxiety. It is often a life-long condition, not dependent upon hearing health news or another potential threat like cancer, though a big scare can fuel its fire as well.

Worried families ask, "What can he do to stay happy?" but what they often mean is that they have the same concerns and want to calm their own fears. The specific plan to combat worry and anxiety is individual, varying from person to person based upon our interests and style. We do not become different people once cancer is found. We experience it in the same way we have gone through other things, and worry is certainly on the docket.

For many, being well-prepared takes much of the unknown out of the weeks or months of treatment. Understanding what is to happen and what others have successfully done to push through is almost universally helpful. Accepting that the worry itself is part of having cancer helps us avoid the very arduous task of trying to stay "happy" during a trying life experience. Best to focus energy elsewhere.

In addition to becoming familiar with the roadmaps and guidebooks of cancer treatment from oncology specialists, veteran patients and their families, other techniques have been well-used to not only minimize worry but also maintain quality of life during treatment and recovery. Although it may seem so basic as to not need special mention, extra attention to proper nutrition and exercise will ease the task of treatment. Somewhat paradoxical, the fatigue, weight loss or gain brings a desire to balance out arduous treatment with rest and comfort foods. An investment of energy and forethought to optimize nutrition and exercise pays off in providing the body with the physical stamina to mold one's emotions and fears as much as is possible. The payoff leads to staying involved rather than in isolation and engaging in activities that make the time uninvolved in treatment meaningful.

The interplay of one's emotions and physical being bear close scrutiny as these connections are strong. Cancer produces cell proteins (from the Greek; cyto-cell, kine-protein) that circulate through the body and are responsible in great part for weight changes, pain, nausea and fatigue. These cytokines flow easily into the brain and can either mimic distress or contribute to our emotional well-being. Chemotherapy enters the brain in small amounts as the molecules are too large to cross the blood-brain barrier, but the little that does seep in is thought to be responsible for changes in intellect and thinking, especially the ability to multi-task and retain new information. These cognitive changes, dubbed "chemobrain" twenty years ago, reinforce our concerns that we will "never be the same" after cancer, though most of these reactions seem time-limited. Other medications used during treatment can simulate worry or an agitation of body and thought, known side effects of some anti-nausea medicines. Common pain relievers commonly bring on tremors — dose-dependent and temporary — and can appear as signs of worry or anxiety to the unfamiliar.

The causes of worry are multi-faceted and so are the antidotes. Apart from more effective understanding, focusing on diversionary activities that are useful is something anyone can accomplish blind to educational level or socioeconomic status. Anti-anxiety medicines can certainly help to some to a great extent, and most patients generally take medication to counteract nausea, such as lorazepam (Ativan© and other brand names). Relaxation exercises, massage, Reiki, acupuncture, and yoga all have good track records in helping offset worry and anxiety. Medications used to lift mood also have their place to counteract anxiety and worry when artfully used in coordination with other cancer treatment.

Though seemingly part of the human cost of cancer, worry and anxiety need not be endured in their strongest forms but can be modified to a great extent with a number of tried and true interventions.